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Breast Cancer


Types of Breast Cancer
 

Ductal carcinoma is the most common form of breast cancer. Tumors form in the cells of the milk ducts, which convey milk to the nipples. Ductal carcinoma can either be invasive, with the potential to spread, or non-invasive.

Lobular carcinoma occurs in the lobules, which are the milk-producing glands. Lobular carcinoma can be invasive, with a tendency to spread, or non-invasive.

Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that affects the dermal lymphatic system. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam.

Recurrent breast cancer means that the cancer has returned after being undetected for a time. Recurrent cancer can occur in the remaining breast tissue, and also at other sites such as the lungs, liver, bones or brain. Even though these tumors are in a new location, they are still called breast cancer.

Symptoms of breast cancer may vary from woman to woman. Women should be familiar with their breasts so that they know what feels and looks normal for them. Changes should be promptly reported to a health care provider. Many cancers are found by regular mammography after age 40 – before any symptoms are felt.

Symptoms include:

  • Lump or mass in your breast
  • Enlarged lymph nodes in the armpit
  • Changes in breast size, shape, skin texture or color
  • Skin redness
  • Dimpling or puckering
  • Nipple changes or discharge
  • Scaliness
  • Nipple pulling to one side or a change in direction

Many breast changes – including lumps – are not cancer, but if you notice one or more of these symptoms for more than two weeks, see your doctor.

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Teaching

At the moment there are no courses of Breast Cancer

Clinical trials
Ensayo de fase III aleatorizado de Palbociclib en combinación con terapia Anti-Her2 más tratamiento endocrino adyuvante estándar frente a tratamiento Anti-Her2 más tratamiento endocrino adyuvante estándar para pacientes con cáncer de mama metastásico con receptores hormonales positivos (RH+) y HER2-positivo
Estudio de fase II de pembrolizumab y eribulina en pacientes con cáncer de mama metastásico receptor hormonal positivo/HER2 negativo previamente tratados con antraciclinas y taxanos
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
Ensayo Clínico Fase II para analizar la Respuesta a Olaparib de pacientes con Metilación del Promotor de BRCA1 y/o 2 diagnosticadas de Cáncer de Mama Avanzado (Estudio COMETA-Breast)
Estudio de Fase II abierto para evaluar la eficacia y la seguridad del tratamiento con SAR566658 en pacientes con Cáncer de Mama metastásico Triple Negativo y CA6 positivo.
Ensayo de fase III aleatorizado de palbociclib con tratamiento endocrino adyuvante estándar frente a monoterapia con tratamiento endocrino adyuvante estándar en cáncer de mama primario con receptores hormonales positivos (RH+) y HER2-negativo.
Estudio de Fase 3, aleatorizado de margetuximab más quimioterapia frente a trastuzumab más quimioterapia en pacientes con cáncer de mama metastásico HER2+ que han recibido dos tratamientos anti-HER2 previos y que precisan tratamiento sistémico.
Ensayo fase III, multicéntrico, aleatorizado, doble ciego, de grupos paralelos, controlado con placebo, para evaluar la eficacia y la seguridad de olaparib frente a placebo como tratamiento adyuvante de pacientes con cáncer de mama HER2 negativo de alto riesgo y mutaciones germinales de BRCA1/2, que han finalizado el tratamiento local y la quimioterapia neoadyuvante o adyuvante
ESTUDIO ABIERTO EN FASE I CON GDC-0927 EN MUJERES POSMENOPÁUSICAS CON CÁNCER DE MAMA LOCALMENTE AVANZADO O METASTÁSICO Y RECEPTORES ESTROGÉNICOS POSITIVOS
Estudio pivotal aleatorizado y multicéntrico de CDX-011 (CR011-vcMMAE) en pacientes con cáncer de mama triple negativo metastásico con sobreexpresión de GPNMB
PRIMER ESTUDIO EN EL SER HUMANO DE LA ADMINISTRACIÓN REPETIDA DE REGN2810, UN ANTICUERPO MONOCLONAL, TOTALMENTE HUMANO FRENTE A LA PROTEÍNA DE MUERTE CELULAR PROGRAMADA 1 (PD-1), EN MONOTERAPIA Y EN COMBINACIÓN CON OTROS TRATAMIENTOS ANTINEOPLÁSICOS, EN PACIENTES CON TUMORES MALIGNOS AVANZADOS
Estudio Fase Ib/II ramdomizado de BI836845 en combinación con Exemestano y Everolimus versus Exemestano y Everolimus, en mujeres con cáncer de mama metastático.
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Nintedanib más Letrozol en pacientes posmenopáusicas con cáncer de mama: Ensayo clínico de fase 0/1 de seguridad y farmacodinámica.
Estudio de fase II, aleatorizado, doble ciego y controlado con placebo, de dicloruro de radio 223 en combinación con terapia hormonal para pacientes con cáncer de mama HER2 negativo, receptores hormonales positivos con metástasis óseas.
Estudio de fase II, aleatorizado, doble ciego y controlado con placebo, de dicloruro de radio 232/placebo en combinación con exemestano y everolimus para pacientes con cáncer de mama HER2 negativo, receptores hormonales positivos con metástasis óseas.
Estudio de fase III, aleatorizado, doble ciego, controlado con placebo de LEE011 o placebo en combinación con tamoxifeno y goserelina o de un inhibidor de la aromatasa no esteroideo (IANE) y goserelina para el tratamiento de mujeres premenopáusicas con cáncer mama avanzado con receptor hormonal positivo, HER2 negativo.
Estudio clínico de fase III, doble ciego, controlado con placebo, aleatorizado, de Taselisib más Fulvestrant frente a placebo más Fulvestrant en mujeres posmenopáusicas con cáncer de mama receptor de estrógeno positivo y Her2 negativo, localmente avanzado o metastásico, que han presentado recidiva o progresión de la enfermedad durante o después del tratamiento con un inhibidor de la aromatasa.
Estudio fase III, multicéntrico, randomizado, controlado con placebo de Ipatasertib (GDC-0068), un inhibidor de AKT, en combinación con Paclitaxel como primera línea de tratamiento para pacientes con cáncer de mama metastásicotriple negativo
Estudio clínico de fase II randomizado, doble ciego de Ipatasertib (GDC-0068), un inhibidor de AKT, en combinación con Paclitaxel como tratamiento neoadyuvante para pacientes con cáncer de mama triple negativo
Estudio clínico de fase II de 2 cohortes de BMN 673 administrado para pacientes con cáncer de mama localmente avanzado o metastásico BRCA mutadas
Estudio de fase II, aleatorizado, de cohortes paralelas, de dos etapas, doble ciego y controlado por placebo de trastuzumab neoadyuvante frente a Trastuzumab+ BKM120 en combinación con Paclitaxel semanal en cáncer de mama primario HER2 positivo con y sin mutaciones en PIK3CA
Estudio Abierto de fase II, con 3 cohortes, de evaluación de la administración oral de Lucitinib en pacientes con cáncer de mama metastasico y receptor estrogénico positivo con FGFR1 amplificado o no
Ensayo clínico en fase 3, aleatorizado, multicéntrico, doble ciego con pd0332991 (inhibidor oral de cdk 4/6) en combinación con Letrozol comparado con placebo más Letrozol en el tratamiento de pacientes posmenopáusicas con cáncer de mama re (+), her2 (-) que no han recibido tratamiento sistémico previo para la enfermedad avanzada
Estudio clínico de fase III multicéntrico, abierto, randomizado para comparar trastuzumab en combinación con pertuzumab más un taxano,​ tras quimioterapia con antraciclinas,​ frente a trastuzumab emtansina en combinación con pertuzumab, tras quimioterapia con antraciclinas, como tratamiento adyuvante en pacientes con cáncer de mama primario her-2 positivo operable
ESTUDIO DE NERATINIB MÁS CAPECITABINA FRENTE A LAPATINIB MÁS CAPECITABINA EN PACIENTES CON CÁNCER DE MAMA METASTÁSICO HER2+ QUE HAN RECIBIDO PREVIAMENTE DOS O MÁS REGÍMENES ANTI-HER2 PARA ENFERMEDAD METASTASICA (NALA)
QUIMIOTERAPIA NEOADYUVANTE CON NAB-PACLITAXEL EN PACIENTES CON CÁNCER DE MAMA HER2 NEGATIVO DE ALTO RIESGO
Estudio fase III aleatorizado, doble ciego, controlado con placebo de BKM120 en combinación con fulvestrant en mujeres postmenopáusicas con cáncer de mama localmente avanzado o metastásico con receptores hormonales positivos HER2 negativo que han progresado mientras o después del tratamiento con un inhibidor de la aromatasa.
Estudio fase II, aleatorizado, abierto, con tres brazos, de everolimus en combinación con exemestano frente a everolimus en monoterapia frente a capecitabina, para el tratamiento de mujeres postmenopáusicas con cáncer de mama con receptor estrogénico positivo, localmente avanzado, recurrente o metastásico después de recurrencia o de progresión a letrozol o anastrozol.
Estudio clínico piloto para evaluar los cambios en biomarcadores de inflamación relacionados con cáncer, en mujeres diagnosticadas con cáncer de mama estadío O-lIlA y sin evidencia de la enfermedad, que recibieron el complemento PhytoMed.
Estudio de fase 1b/2 aleatorizado de MEDI-573 en combinación con un inhibidor de la aromatasa (IA) frente a un IA en monoterapia en mujeres con cáncer de mama metastásico (CMM). A phase IB/II Randomized study of MEDI-573 in combination with an Aromatase inhibitor AI versus AI Alone in women with Metatasic Breast Cancer MBD.
El estudio BEACON (BrEAst Cancer Outcomes with NKTR-102; Resultados del cáncer de mama con NKTR-102): Estudio de fase 3, abierto, aleatorizado y multicéntrico de NKTR-102 frente al tratamiento elegido por el médico (TEM) en pacientes con cáncer de mama localmente recurrente o metastásico tratadas previamente con una Antraciclina, un Taxano y Capecitabina.
Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.
Estudio fase II, aleatorizado, doble ciego, controlado con placebo, de BKM120 más paclitaxel, en pacientes con cáncer de mama metastático o localmente avanzado inoperable, HER2 negativo, con o sin activación de la vía de señalización PI3K
Estudio multicéntrico, abierto, con un solo grupo de tratamiento, de pertuzumab en combinación con trastuzumab y un taxano como tratamiento de primera línea de pacientes con cáncer de mama avanzado (metastásico o localmente recurrente) HER2-positivo.
Estudio multicéntrico, doble ciego, randomizado, controlado con placebo, para comparar quimioterapia más trastuzumab y placebo con quimioterapia más trastuzumab y pertuzumab, como tratamiento adyuvante en pacientes con cáncer de mama primario her2-positivo operable.
Estudio aleatorizado abierto de acetato de abiraterona (JNJ-212082) más prednisona con o sin exemestano en mujeres posmenopáusicas con cáncer de mama metastásico ER+ que muestran progresión después del tratamiento con letrozol o anastrozol
LUX-Breast 1: Estudio de Fase III, aleatorizado, abierto, de BIBW 2992 combinado con vinorelbina versus trastuzumab combinado con vinorelbina en pacientes con cáncer de mama metastásico con sobreexpresión del HER2 que fracasaron a un tratamiento previo con trastuzumab
Ensayo de fase III, aletorizado, multicéntrico, de dos grupos, abierto, para evaluar la eficacia de T-DM1 en comparación con el tratamiento elegido por el médico en pacientes con cáncer de mama metastásico HER2-POSITIVO que han recibido como mínimo dos pautas previas de tratamiento dirigido contra HER2
Estudio fase III randomizado para evaluar la eficacia y seguridad del tratamiento continuado y de reinducción con bevacizumab en combinación con quimioterapia en pacientes con cáncer de mama localmente recurrente o metastásico tras el tratamiento de primera línea con quimioterapia y Bevacizumab.
Ensayo de fase III, aleatorizado, en doble ciego y controlado con placebo, de capecitabina más sorafenib en comparación con capecitabina más placebo en el tratamiento del cáncer de mama HER2-negativo localmente avanzado o metastásico.
Ensayo Clínico de fase I/II, aletorizado, de paclitaxel neoadyuvante frente a perinclusión con BIBF 1120 seguida por BIBF 1120 más paclitaxel en cancer de mama inicial HER-2 negativo con correlaciones proteomicas y pruebas de imagen dinamicas

Many factors may influence the development of breast cancer, including:

  • Age. Most cases occur in women 50 or older; it is less common in women 35 or younger. Age is the most influential risk factor.
  • Family history. Your risk is higher with a family history (especially mother, sister, daughter) of breast and/or ovarian cancer.
  • Hormones / childbirth. Your risk is higher if you had your first period before age 12, began menopause after age 55, never had children or had your first child after age 30. Postmenopausal use of hormonal therapy increases your risk of developing breast cancer.
  • Previous biopsy. If you’ve had abnormal breast biopsy results or benign breast diseases requiring biopsies, you may be at increased risk. Other breast diseases such as atypical hyperplasia, lobular or ductal carcinoma in situ are risk factors, too.
  • Education / socioeconomic status. Women with a higher socioeconomic status and/or education tend to have fewer children and start childbearing after age 30 – both of which put them at higher risk.
  • Weight. Obesity or weight gain after menopause are risk factors.

Genetic alterations. Inherited susceptibility genes BRCA1 and BRCA2 account for about five to 10% of all breast cancer cases.
 
Other risk factors include:

  • Oral contraceptive use
  • A diet high in saturated fats
  • Physical inactivity
  • Alcohol (more than one alcoholic drink a day)

 
Screening Tests
Breast cancer screening tests are performed on healthy women with no symptoms on a regular basis. Regular screening exams help catch cancer in its early stages, when it is much more likely to respond to treatment. Typical breast screening exams include:

Clinical breast exam: your physician will visually examine your breasts and manipulate them manually to feel for lumps or other breast changes. Clinical breast exams should be performed every one to three years beginning at age 20, and every year beginning at age 40.

Mammogram: Each breast is placed between two photographic plates and compressed, while an X-ray is taken of the breast tissue. Mammograms should be conducted every year beginning at age 40 and possibly earlier if a woman has certain risk factors such as inherited genetic mutations.

In addition to the screening exams above, women should also practice breast “self-awareness.” Becoming familiar with your breasts makes it much more likely that you will notice changes that may signal cancer or another health condition.

There are several procedures that can be used to diagnose breast cancer. Not every procedure will be done for each patient. The evaluation is based upon the patient’s examination and physician recommendations.

Biopsy: a small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies can be done in the following ways:

Surgical biopsy: an incision is made in the breast. Surgeons locate the tumor by palpation or with the aid of images from a CT scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, only a portion of the tumor is removed.

Fine Needle Aspiration (FNA): a thin, hollow needle is inserted into the breast to the tumor, and fluid and cells are removed from the tumor. While this test can help to determine if there is cancer present, it cannot determine if the cancer is invasive and additional biopsies may be needed if cancer is actually present.

Core biopsy: a thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.

Diagnostic mammogram: this procedure is similar to the mammogram used for screening, but provides more detailed images of the breast tissue.  

Magnetic Resonance Imaging (MRI): images of the breast are created with powerful magnets that interact with a computer.

Ultrasound: a special wand placed against the skin transmits sound waves, which bounce off breast tissue and are used create an image on a monitor. 

Sentinel lymph node biopsy: lymph nodes are olive-sized glands which are part of a system that circulates lymph fluid throughout the body. The lymphatic system can also carry cancer cells from the tumor site to other areas of the body. In breast cancer patients, the first nodes to be affected are under the arm.

In a sentinel lymph node biopsy, a radioactive tracer is injected into the area before surgery. Then, the surgeon injects a blue dye near the tumorsite, which shows up in cancerous lymph nodes. The node with the highest amount of tracer or blue dye is the “sentinel” node.  The surgeon removes all nodes with blue dye. This procedure can spare healthy lymph nodes, which results in fewer side-effects such as lymphedema. 

 
Staging
(Source: National Cancer Institute)

The staging system allows doctors to help identify the extent of breast cancer involvement. By knowing the extent of disease, doctors can then determine the best treatment for each patient.

Stage 0 (carcinoma in situ): cancer has not spread from the site of origin.

There are 2 types of breast carcinoma in situ:

Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.

Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.

Stage I: Cancer has formed. The tumor is 2 centimeters or smaller and has not spread outside the breast.

Stage IIA

No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB

The tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA

No tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or
The tumor is 2 centimeters or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIB: The tumor may be any size and cancer:

Has spread to the chest wall and/or the skin of the breast; and
May have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIC: There may be no sign of cancer in the breast or the tumormay be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer:

Has spread to lymph nodes above or below the collarbone; and
May have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IIIC breast cancer is divided into operable and inoperable stages:

In operable stage IIIC, the cancer is found in:

10 or more axillary lymph nodes; or
Lymph nodes below the collarbone; or
Axillary lymph nodes and in lymph nodes near the breastbone
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.

Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Surgery
Surgery is the most common treatment for breast cancer. Surgery to remove one or both breasts is called mastectomy. The entire breast is removed, along with any affected lymph nodes. In about 80% of mastectomies, breast reconstruction or implant surgery is performed during the same procedure, after the breast is removed.

Breast-sparing surgery is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I & II) tumors. Breast-sparing techniques include:

Lumpectomy: the tumor and a small margin of healthy breast tissue are removed.

Partial mastectomy: the tumor is removed, along with a margin of healthy breast tissue, the lining of the chest muscles, and any affected lymph nodes under the arm.

 
Radiation Therapy
Radiation therapy uses high-energy beams to destroy cancer cells. There are two types of radiation treatment for breast cancer:

External beam radiation: the beams are aimed at the tumor from outside the body. Patients undergo radiation five days a week for a certain number of weeks.

Internal radiation: tiny plastic tubes filled with radioactive material are implanted in the breast at the tumor site and are removed after several days. This procedure requires a hospital stay.

Women who have undergone breast-sparing surgery and/or mastectomymay receive radiation afterwards to kill any lingering cancer cells. Radiation can also be used before surgery to shrink large tumors or to treat tumors in a difficult location.

The following technological means and types of radiation therapy are used with this disease:

  • Virtual CT simulation
  • Intensity modulated radiartio therapy (IMRT)
  • Respiratory Gating

Chemotherapy
Chemotherapy is the use of drugs, either alone or in combination, to kill cancer cells. In breast cancer, chemotherapy is most often used either before or after surgery, or as a primary treatment for cancer that has spread outside the breast at the time of diagnosis.

Hormone Therapy
Hormone therapy is used to prevent female hormones (estrogen, progesterone and estradiol) from fueling the growth of breast tumors in some patients. Hormone therapy can involve taking drugs, either by mouth or through an IV. Tamoxifen is an example of a hormone therapy drug. Surgery to remove the ovaries in women who have not yet reached menopause is another type of hormone therapy.

Biologic Therapy
Biologic therapy is a drug treatment that helps the body’s immune system fight cancer.